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Abstract
Adaptive radiotherapy emerged over 20 years ago and is now an established clinical
practice in a number of organ sites. No one solution for adaptive therapy exists.
Rather, adaptive radiotherapy is a process which combines multiple tools for imaging,
assessment of need for adaptation, treatment planning, and quality assurance of this
process. Workflow is therefore a critical aspect to ensure safe, effective, and efficient
implementation of adaptive radiotherapy. In this work, we discuss the tools for online
and offline adaptive radiotherapy and introduce workflow concepts for these types
of adaptive radiotherapy. Common themes and differences between the workflows are
introduced and controversies and areas of active research are discussed.